Policy for Failure to Bring/Attend Children s Health Appointments Whittington Health 2012/2013

Transcription

1 Policy for Failure to Bring/Attend Children s Health Appointments Whittington Health 2012/2013 Subject: Policy Number: 1 Ratified by: Policy for Failure to Bring/Attend and Cancellation of Children s Health Appointments 1.Safeguarding Children Committee 2.Clinical Policy Approval Group Date Ratified: 1.vember January 2013 Version: One Policy Executive Owner: Director of Nursing and Patient Experience Designation of Author: Named Nurse for Child Protection Name of Assurance Committee: Quality Committee Date Issued: vember 2012 Review Date: vember 2014 Target Audience: All Clinical Staff and administrative staff Key Words: Children; Young People; Safeguarding Children; DNA; FTA; NAV; FTC; UTA, WNB 1

2 Contents Paragraph Title Page Number 1 Background 4 2 Definitions Was t Brought (WNB) or Did t Attend (DNA) Access Visits (NAV) Failure To Consent (FTC) Unable To Attend (UTA) 4 3 Key Principles of Practice Organisations Professionals should Managing WNB/ DNA 6-8 Audit 8 DNA Process Flow Chart 9 References 10 2

3 Version Control Sheet Version Date Author Status Comment 1 January 2013 Named Nurse Ratified First integrated care organisation document for hospital and community 3

4 1. Background This policy is written in line with the National Service Framework for Children, Young People and Maternity Services (2003; 2004), Working Together to Safeguard Children (2010) Section 11 of The Children Act (2004). Many Serious Case Reviews/Homicide Reviews, both nationally and regionally have featured non-attendance (DNA) and failed access visits (NAV) as a precursor to neglect, serious child abuse and child death. The policy is intended to support health professionals working in Whittington Health in assessing the risk to children and young people when appointments are missed. It can also be used to assess the risk to a child or young person should parents/carers fail to return consent forms for health appointments. 2. Definitions 2.1 WAS NOT BROUGHT (WNB) Applies to children and young people (who require the presence of a parent or carer to attend appointments) who did not attend a planned appointment and had not cancelled the appointment. 2.2 DID NOT ATTEND (DNA) Applies adolescents & young people, (who are old enough to attend appointments without a parent or carer) or to the parents/carers of children who did not attend a planned appointment and had not cancelled the appointment. 2.3 NO ACCESS VISITS (NAV) Applies to families who are not available at home to be seen for a planned appointment. 2.4 FAILURE TO CONSENT (FTC) Applies to parents/carers who omit to return consent to treatment forms for health services provided within school settings. 2.5 UNABLE TO ATTEND (UTA) Applies to children and young people and/or their parents/carers who cancel appointments. For the purpose of this document DNA applies to all the above. 3. Key Principles for Practice 3.1 Organisations A child is defined as a person from birth up to their 18 th birthday. Some children may then become vulnerable adults. Children have the right to access and receive medical care. Parents/those with parental responsibility are responsible for ensuring the child is brought to health and other appointments. 4

5 It is therefore, in most cases, not that the child has failed to attend, but that the parent/carer has failed to bring them. For this reason the term Was t Brought should be used to describe this type of failure to attend appointments in all documentation & correspondence. In adolescence the child may choose not to attend. If this is the case consideration should be given to whether the child is putting themselves at risk of significant harm by failing to attend. Consideration should be given to the child s ability to make a decision, their level of, maturity, knowledge and understanding regarding the implications of their decision ie. Are they Gillick competent? Failure to bring the child to health appointments may be an indicator of neglect, which is a category of child abuse. Health service provision should be child and young person friendly and work in partnership with parents, carers and other practitioners. Health services should ensure that all health service provision is accessible to families and that the timing of appointed clinics or home visits and the location of services are reviewed to optimise the opportunities for children and families to attend. Where a young person is competent to consent to treatment and care, health services should ensure that there is provision for them to access care on their own (i.e. without their parent or legal guardian) if they wish to do this. 3.2 Professionals should: Be mindful that all children should be offered appropriate therapeutic and preventative interventions (Working Together to Safeguard Children, 2010). However, parents/carers may choose to disengage with health care for themselves or their children. Remember disengagement is a key risk factor for children and families and may be a precursor to something more serious happening. Be child focused and consider children and young people even when the DNA relates to the parents/carer, for example, when mental health, problematic substance misuse and/or domestic violence issues are featured. Be mindful that parental issues such as mental ill health or substance misuse may impact on their ability to parent and to bring there child to their health appointments. Consideration should be given to the impact of the parent/carers behaviour on the child e.g. is the parental mental ill health impairing on their ability to care for the child, including their ability to bring the child to appointments. Does this require a referral to Children s Social Care? Consider the potential negative impact and risk on the health and wellbeing of the child of the parent/carer s failure to bring the child for the health appointment Decide on a reasonable and safe timescale in which the child should be seen 5

6 If there is considerable concern regarding the need for the health appointment then consideration should be given to seeing the child in an alternative setting e.g. day care, the community, if it is not possible to find a timely alternative clinic slot Ensure professionals are appropriately trained in the identification of child maltreatment, to ensure effective judgements are made as to whether the child or young person's health and development are subject to impairment Maintain and develop robust communication links with parents and other professionals involved with the child/young person and ensure that any outcome or consequence for the child or young person is explained Know when, with whom and what proportion of information to share when there are concerns about a child or young person's health and well being and where to seek advice Remember that each case needs to be considered individually and a decision based on analysis of the case, consideration of the risk to the child based around the professional judgement of the team Record and document risk assessments, analysis, communications and actions taken, in the child/young person health record Keep updated with current local guidelines and policies relating to safeguarding children 3.3 Managing WNB/DNA Risk Assessment Following WNB/DNA the responsibility for any risk assessment of the situation rests with the practitioner to whom the child/young person has been referred in conjunction with the referrer. (Laming 2003). Professionals should: Refer to the risk assessment prompt Appendix 1 to support their decision making to determine whether there are any safeguarding children concerns Consider the needs of the child/young person and the capacity of parents/carers to meet those needs Consider the environmental context of the child or young person's situation Consider the appropriateness of a written appointment letter to family s when there is language, cognitive and/or literacy issues, whatever they are able to read and/or understand the appointment letter and to consider other ways of informing parents/carers of the child s appointment e.g. telephone contact, language line Identify whether further action is required to secure the child's health and well being, whether the patient is a child/young person or parent/carer 6

7 Consider the need to seek advice from the Safeguarding Children Team in order to support decision making and future care planning Consider the need to compile a health chronology to demonstrate neglect as a result of persistent failure to attend appointments. Communication Verbal and written communication with parents/carers needs to outline any further action as a possible consequence of WNB/DNA on the child Where there are concerns relating to children then information should be shared with other members of the health care team working with the family who can add to the information sharing process using the Common Assessment Framework (CAF) Where there are concerns relating to safeguarding children, information maybe shared and advice sought from a Child Protection Advisor/Specialist Child Protection Health Visitor or Named Professional or Children Social Care Where there are clear child protection children concerns professionals must discuss this with Children s Social Care as soon as possible and send written referral within 48 hours in accordance with Local Authority Safeguarding Children Board Procedures. Record Keeping Action The content of any discussions with the family and young person relating to WNB/DNA should be clearly documented along with any actions and outcomes in the child or parent /carer record and in health records The content of any discussions with other professionals relating to WNB/DNA should also be clearly documented in health records Analysis conclusion and action plan should also be documented in health records A clear list of WNB/DNA s and cancelled appointments should be recorded. Health chronology s to be included. Consider arranging another appointment, check addresses, and other details for accuracy Ensure parents or carers are informed in writing about any action taken as a result of further non-attendance for the child/young person and with whom information will be shared should there be further WNB s/dna s. This letter should be shared with the child s GP and primary care nurse e.g. Health Visitor or Specialist Nurse and social worker. Consideration needs to be given as to how parents/carers with language, cognitive and/or literacy issues will be informed of the above Where there are known child protection children concerns, the allocated Social Worker, GP, Health Visitor and School Nurse must be informed in writing. 7

8 Audit Repeated WNB s/dnas should result in a discussion/meeting with health colleagues to consider the individual circumstance of the case and then agree the best course of action. The agreed plan of action should be documented in the child s records An integrated approach using the Common Assessment Framework (CAF) should be considered. Discussion should take place with the relevant professional for safeguarding children to assess risk and to formulate an action plan. Where there are repeated WNB S/DNA raising safeguarding concerns these cases should be brought to safeguarding children supervision A referral to Children's Social Care should be made where it is recognised that the child/young person needs further assessment / support or when there is a safeguarding children or child protection concern. If there are significant concerns about the risk to the child then a telephone referral must be made to Children s Social Care immediately and this must be followed up in writing within 48 hours Whittington Health service providers should collect information in respect of WNB/DNA, to improve the uptake of services in order to safeguard children and improve health outcomes. Audit of WNB/DNA will be a part of the safeguarding children committee annual audit plan, monitored by the safeguarding children committee. 8

9 WNB/DNA Process Flow Chart First contact with family Appointment letter / request for consent sent Follow up contact with family Appointment letter sent or appt already made Does family attend or respond? Continue with scheduled care Does family attend or respond? Was it a Choose & Book appointment Are contact details correct? Update details and re-send appointment If nattendance after re-send start from top of algorithm Are contact details correct? Re-book appointment with details of request for action Continue with scheduled care Does family attend or respond? Is it appropriate to discharge without further action? Continue to discharge Copy letter to Health Visitor When child is < 5yrs Liaise with referrer and/or professional +/- GP to make joint decision After discussion is it appropriate to discharge without further action? Refer to other agency as appropriate e.g. children s social care. Consider referral to another health Policy for Failure to Bring/Attend Children s Health Appointments service if needed. Whittington Health 2012/2013 Cressida Zielinski Named Nurse January Record 2013 Version actions 1 taken in child s records electronic or paper 9

10 References 1. National Service Framework for Children and Young People and Maternity Services (DH 2003, 2004). 2. Working Together to Safeguard Children (DCSF 2010) 3. The Children Act (DCSF 1989, 2004) 4. Whittington Health Safeguarding Children Supervision Policy(2012) 5. Framework for the Assessment of Children in Need and their Families (DH 2000) 6. London Child Protection Procedures (Fourth Edition, 2010) 7. Gillick v West rfolk & Wisbech AHA & DHSS [1985] 3 WLR (HL). Links to other Whittington Health documents Procedure for Women who Do t Attend (DNA) for Antenatal (AN) Appointments 2012 For further advice and consultation: cases may be discussed with your line manager, the Child Protection Advisors, Specialist Child Protection Health Visitors, Named Nurse, Paediatric Liaison Nurse Health Visitor,Named Doctor or Named Midwife as appropriate. The Child Protection Team s contact details are available on the Trust intranet Useful Websites (then go to the Safeguarding Children page)

11 Tool to Develop Monitoring Arrangements for Policies What key element(s) need(s) monitoring as per local approved policy or guidance? Who will lead on this aspect of monitoring? Name the lead and what is the role of the multidisciplinary team or others if any. What tool will be used to monitor/check/observe/assess/ins pect/ authenticate that everything is working according to this key element from the approved policy? How often is the need to monitor each element? How often is the need complete a report? How often is the need to share the report? What committee will the completed report go to? Element to be monitored Lead Tool Frequency Reporting arrangements Is the policy being adhered to The Named Professionals To be developed by Safeguarding Team Annually Safeguarding Children Committee Quality Committee Trust Board 11

12 To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval / Comments 1. Does the procedural document affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the procedural document likely to be negative? 5. If so can the impact be avoided? N/A 6. What alternatives are there to achieving the procedural document without the impact? 7. Can we reduce the impact by taking different action? N/A N/A If you have identified a potential discriminatory impact of this procedural document, please refer it to the Director of Human Resources, together with any suggestions as to the action required to avoid/reduce this impact. 12

13 Checklist for the Review and Approval of Procedural Document To be completed and attached to any procedural document when submitted to the relevant committee for consideration and approval. 1. Title Title of document being reviewed: / Comments Is the title clear and unambiguous? Is it clear whether the document is a guideline, policy, protocol or standard? 2. Rationale Are reasons for development of the document stated? 3. Development Process Is it clear that the relevant people/groups have been involved in the development of the document? Are people involved in the development? Is there evidence of consultation with stakeholders and users? 4. Content Is the objective of the document clear? Is the target population clear and unambiguous? Are the intended outcomes described? 5. Evidence Base Are key references cited in full? Are supporting documents referenced? 6. Approval Does the document identify which committee/ group will approve it? 7. Dissemination and Implementation Is there an outline/plan to identify how this will be done? 8. Document Control To be disseminated to Consultants, Health Visitors and School Nurses Forums and DMT s Does the document identify where it will be held? The Intranet Policies Section and SGC intranet pages 9. Process to Monitor Compliance and Effectiveness 13

14 Title of document being reviewed: Are there measurable standards or KPIs to support the monitoring of compliance with and effectiveness of the document? Is there a plan to review or audit compliance with the document? 10. Review Date Is the review date identified? Is the frequency of review identified? If so is it acceptable? 11. Overall Responsibility for the Document Is it clear who will be responsible for co-ordinating the dissemination, implementation and review of the document? / Being developed Named Nurses Comments Executive Sponsor Approval If you approve the document, please sign and date it and forward to the author. Procedural documents will not be forwarded for ratification without Executive Sponsor Approval Name Bronagh Scott Date Signature Relevant Committee Approval The Director of Nursing and Patient Experience s signature below confirms that this procedural document was ratified by the appropriate Governance Committee. Name Bronagh Scott Date Signature Responsible Committee Approval only applies to reviewed procedural documents with minor changes The Committee Chair s signature below confirms that this procedural document was ratified by the responsible Committee Name Date Name of Committee Signature Name & role of Committee Chair 14